| NPI | 1184074320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 023401) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 12794) |
| Enumeration Date | 2016-06-19 |
| Last Update Date | 2017-12-17 |